Using mHealth to investigate cancer inequities: The impact of discrimination on tobacco cessation among underserved populations

项目摘要/摘要 吸烟是美国边缘化社区发病率和死亡率的主要原因，例如 黑人/非裔美国人(B/AA)以及性少数和性别少数(SGM)患上 与吸烟有关的癌症和可能阻碍成功戒烟的独特的社会和背景压力因素。为 例如，B/AA和SGM经历了普遍的少数群体压力来源(例如，污名化和歧视) 已知会对心理健康、健康行为和身体健康结果产生负面影响。虽然涉及面广 有研究将B/AA和SGM的当前吸烟行为与感知到的歧视联系起来，没有研究 研究了歧视如何影响这些群体中的戒烟行为。移动医疗(MHealth) 生态瞬时评估(EMA)和可穿戴设备套件AutoSense等技术 生理传感器--可以对戒烟期间的生活体验进行实时、真实的评估 试图预测吸烟行为，并为适应性干预的发展提供信息。的目标是 建议的研究是使用移动健康方法通过以下方式促进对该机制的现有知识 B/AA和SGM在癌症风险方面的不平等是由哪些少数民族应激源，如歧视造成的。 AIM 1将利用最近完成的一项研究的数据来分析连接实时、真实世界的路径 B/AA组(N=300)在戒烟尝试过程中有过歧视和吸烟的经历。AIM 2将利用 来自一项正在进行的研究的数据，以阐明将实时、真实的歧视经验联系起来的途径 和吸烟在SGM戒烟尝试期间的变化，并进一步比较歧视的经历， SGM和非SGM之间的相关个人经历(例如，压力、情感)和吸烟失误 在退出尝试期间(N=375[300非SGM+75 SGM])。假设的关键机制是调解 歧视和戒烟之间的时间关联是压力、负面情绪、冲动和自我 功效。这项研究将在亨斯迈癌症研究所进行，该研究所是NCI指定的癌症中心 提供特别支持和协作的培训环境。申请者的综合 与专家指导小组共同制定的培训计划将直接支持完成 建议的研究和补充申请人在癌症不平等研究方面的先前培训。团契 培训目标侧重于：1)用于分析密集纵向数据的先进统计方法；2)移动健康 评估和干预方法；3)初级癌症预防和戒烟；4)健康 不平等和健康的社会决定因素；和5)职业发展，包括赠款的编写， 研究传播、研究伦理和指导。拟议的研究和培训活动将 为申请人提供必要的知识和技能，以建立一个独立和 致力于消除癌症控制连续体中癌症不平等的生产性研究计划。

PROJECT SUMMARY/ABSTRACT Cigarette smoking is a leading cause of morbidity and mortality in the U.S. Marginalized communities, such as Black/African Americans (B/AA) and sexual and gender minorities (SGM), experience increased risk for smoking-related cancers and unique social and contextual stressors that may hinder successful quitting. For example, B/AA and SGM experience pervasive minority stressors (e.g., stigmatization and discrimination) known to negatively impact mental health, health behaviors, and physical health outcomes. Although extensive research has linked perceived discrimination with current smoking behavior among B/AA and SGM, no studies have examined how discrimination impacts smoking cessation within these groups. Mobile health (mHealth) technologies such as ecological momentary assessment (EMA) and AutoSense – a suite of wearable physiological sensors – can provide real-time, real-world assessments of lived experiences during a quit attempt to predict smoking behavior and inform the development of adaptive interventions. The objective of the proposed research is to use mHealth approaches to advance current knowledge of the mechanisms by which minority stressors such as discrimination contribute to inequities in cancer risk among B/AA and SGM. Aim 1 will utilize data from a recently completed study to analyze pathways linking real-time, real-world experiences of discrimination and smoking lapse during a quit attempt among B/AA (N = 300). Aim 2 will utilize data from an ongoing study to elucidate pathways linking real-time, real-world experiences of discrimination and smoking lapse during a quit attempt among SGM, and further compare experiences of discrimination, associated intrapersonal experiences (e.g., stress, affect), and smoking lapse between SGM and non-SGM during a quit attempt (N = 375 [300 non-SGM + 75 SGM]). Key mechanisms hypothesized to mediate the temporal association between discrimination and smoking lapse are stress, negative affect, urge, and self- efficacy. This research will be conducted at Huntsman Cancer Institute, an NCI-Designated Cancer Center that offers an exceptionally supportive and collaborative training environment. The applicant’s comprehensive training plan, developed in conjunction with an expert mentoring team, will directly support the completion of the proposed research and complement the applicant’s prior training in cancer inequities research. Fellowship training goals focus on: 1) advanced statistical methods for analyzing intensive longitudinal data; 2) mHealth assessment and intervention approaches; 3) primary cancer prevention and smoking cessation; 4) health inequities and the social determinants of health; and 5) professional development, including grant writing, research dissemination, research ethics, and mentoring. The proposed research and training activities will provide the applicant with the necessary knowledge and skills needed to establish an independent and productive research program dedicated to eliminating cancer inequities across the cancer control continuum.